Erectile Dysfunction Should Be a Marker For Diabetes

MedicalResearch.com Interview with:

Damiano Pizzol  Operational Research Unit, Doctors with Africa Cuamm Beira, Mozambique

Damiano Pizzol 

Damiano Pizzol 
Operational Research Unit, Doctors with Africa Cuamm
Beira, Mozambique

MedicalResearch.com: What is the background for this study?

Response: Since the 1970s the association between diabetes and the development of erectile dysfunction has been documented both in animal models and humans Several studies have considered the prevalence of erectile dysfunction in diabetes and the majority agree that the incidence of erectile dysfunction in men with diabetes is two- to three-fold higher than in the general population. It is estimated that erectile dysfunction affects up to 75% of all men with diabetes, it is age correlated and occurs at a younger age in men with diabetes.
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Gout Linked To Raised Risk of Erectile Dysfunction

MedicalResearch.com Interview with:

Dr Edward Roddy Clinical Senior Lecturer in Rheumatology and Honorary Consultant Rheumatologist Arthritis Research UK Primary Care Centre Research Institute for Primary Care & Health Sciences Keele University Staffordshire UK

Dr. Edward Roddy

Dr Edward Roddy
Clinical Senior Lecturer in Rheumatology and Honorary Consultant Rheumatologist
Arthritis Research UK Primary Care Centre
Research Institute for Primary Care & Health Sciences
Keele University
Staffordshire UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Both gout and erectile dysfunction (ED) are prevalent in the general population, and share some common risk factors such as obesity, alcohol consumption and comorbidity (vascular disease, renal disease etc). We undertook a retrospective cohort study in UK Clinical Practice Research Database, a large longitudinal UK database of UK computerised primary care records, to quantify the risk of incident ED in men with gout. We found that men with gout had 30% greater risk of developing erectile dysfunction than men without gout, after adjusting for confounding variables such as lifestyle factors and comorbidity, although the absolute increased risk was small (0.6%). We did a further analyses including men who already had ED when they were diagnosed with gout, finding that they were also at increased risk of being diagnosed with ED in the year before they developed gout, suggesting that hyperuricaemia, which people can have for decades before developing gout, may be a key reason to explain the increased risk of erectile dysfunction in people with gout.

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Data For Risk of Prostate Cancer with Drugs for Erectile Dysfunction Mixed

MedicalResearch.com Interview with:

Juzar Jamnagerwalla, MD Division of Urology, Department of Surgery Cedars-Sinai Medical Center Los Angeles, California

Dr. Juzar Jamnagerwalla

Juzar Jamnagerwalla, MD
Division of Urology, Department of Surgery
Cedars-Sinai Medical Center
Los Angeles, California

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In mouse models phosphodiesterase type-5 inhibitors (PDE-5i) have been shown to have anti-neoplastic activity, and given the routine use of PDE-5i for treatment of erectile dysfunction after prostatectomy several studies have examined the association between PDE-5i use and biochemical recurrence after treatment for prostate cancer with mixed findings. Only one previous study has explored the association between risk of prostate cancer, finding that men on PDE-5i had a lower chance of being diagnosed with prostate cancer. Given this, we tested the relationship between PDE-5i use and risk of prostate cancer in 6,501 men in the REDUCE study finding that PDE-5i use was not associated with prostate cancer diagnosis. On secondary analysis, among North American men who had a much higher baseline use of PDE-5i use, there was an inverse association between PDE-5i use and prostate cancer diagnosis, which approached, but did not reach statistical significance.

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Erectile Dysfunction Drugs Unlikely to Cause Increase in Melanoma

MedicalResearch.com Interview with:
Anthony Matthews
Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine
London, United Kingdom

MedicalResearch.com: What is the background for this study?

Dr. Mathews: :The drug Viagra, which is used to treat erectile dysfunction, is one of a class of drugs called PDE5 inhibitors. Laboratory studies of cells from the skin cancer, malignant melanoma, suggest that PDE5 inhibitors might promote their growth, so there have been some concerns that people using these drugs might have an increased risk of malignant melanoma. Two previous studies comparing melanoma rates in PDE5 inhibitor users and non-users came to differing conclusions so we wanted to look further into this. To carry out the study we used anonymised GP records from the UK identifying over 150,000 men with a PDE5 inhibitor prescription, and over 500,000 men of a similar age, and from the same areas, who didn’t have a PDE5 inhibitor prescription. We then looked for later diagnoses of malignant melanoma to see how people’s exposure to PDE5 inhibitors affected their future risk of being diagnosed with melanoma.
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Stem Cells May Improve Blood Flow In Patients With Erectile Dysfunction

MedicalResearch.com Interview with:

Dr. Michael Zahalsky MD Medical Director of Urological Oncology North Broward Medical Center, Florida

Dr. Michael Zahalsky

Dr. Michael Zahalsky MD
Medical Director of Urological Oncology
North Broward Medical Center, Florida

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Zahalsky: Erectile dysfunction or the inability to maintain an erection satisfactory for sexual intercourse is a disease that affects hundreds of millions of men worldwide. Currently, the most utilized methods to help treat these men include oral medications, injectable medications and penile prostheses.

We sought out new alternatives to treat and potentially even cure erectile dysfunction by using stem cells and biologic-based therapies – treatments that are now being used in various fields of medicine from orthopedics to plastic surgery. We decided to see how their effect will influence Erectile Dysfunction by evaluating blood flow to the penis. In the past we studied Peyronie’s Disease using a similar treatment modality and showed that with a single injection blood flow improved, plaque size decreased, and penile curvature lessened.  There have been many animal studies, as well, showing the benefit of biologic-based therapies in the treatment of Erectile Dysfunction and Peyronie’s Disease.

We chose to use placental matrix derived mesenchymal stem cells in this study on Erectile Dysfunction. We had a small sample of 8 patients who underwent treatment. We had statistically significant increase in blood flow into the penis.  This was demonstrated by an increase in peak systolic velocity using color doppler on ultrasound.

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Individualized Surgery Helps Preserve Erectile Function in High Risk Prostate Cancer Patients

Medicalresearch.com Interview with:
Dr. Pedro Recabal, MD and
Memorial Sloan Kettering Cancer Center Department of Surgery,
Urology Service New York, NY
Urology service, Fundacion Arturo Lopez Perez, Santiago, Chile
Dr. Vincent P. Laudone,
Memorial Sloan Kettering Cancer Center Department of Surgery
Urology Service New York, NY

Medicalresearch.com What is the background for this study?

Response:  One of the most concerning adverse events that may arise following surgery for prostate cancer (radical prostatectomy) is postoperative erectile dysfunction. The loss of erectile function after surgery is most frequently caused by intraoperative injury to the neurovascular bundles, tiny packages of blood vessels and nerves that conduct the impulses responsible for erection. It is known that if both bundles are removed, patients seldom recover erectile function. Accordingly, neurovascular bundle preservation during Radical prostatectomy has proven benefits in terms of erectile function recovery.

However, as these bundles are intimately associated with the posterolateral aspects of the prostate, they must be carefully separated from the surface of the prostate without cutting them, applying excessive traction, or using cautery, all of which could produce irreversible damage and the consequent loss of function. During this dissection, the surgeon risks cutting into the prostatic capsule , which could result in leaving tumor behind. In some cases, the tumor extends beyond the prostate into the neurovascular bundles, and an attempt to preserve these structures could also result in incomplete tumor removal, defeating the purpose of radical prostatectomy.

Therefore, many urologists treating patients with “aggressive” tumors (such as the patients in our cohort) would try to avoid leaving cancer behind by removing not only the prostate but also the tissue around it, including the neurovascular bundles. In other words, if you had to chose between removing all the cancer but loosing erectile function, or preserving erectile function but risking an incomplete cancer removal, most patients and surgeons naturally lean towards the first option. Also, in many centers, patients with aggressive prostate cancers are managed with combined treatments (multimodal therapy), by adding hormonal therapy and/or radiotherapy, which could also result in erectile dysfunction. As such, many surgeons believe that there is no rationale for attempting to preserve the neurovascular bundles in these “high-risk” patients because most will end up with erectile dysfunction .

However, with the advent of MRI (and integrating other clinical information such as location of the positive biopsies, and intraoperative cues), surgeons can now have a better idea of where the cancer is located, which may aid in surgical planning. For instance, if a tumor is located in the anterior prostate, removing the neurovascular bundles (located on the posterolateral aspects) would provide no oncologic benefit, regardless of the aggressiveness of the tumor. Similarly, if the tumor compromises only the left side, removing the right neurovascular bundle is unlikely to help the patient, but can instead result in harm.

Moreover, neurovascular bundle preservation is not an all-or-none procedure; on each side, these bundles can be completely preserved (meaning dissecting exactly along the border between the prostate and the bundle); partially preserved (meaning preserving some of the nerves that are further away from the prostate, and removing the ones that are closer to the prostate); or completely removed along with the prostate (This has been graded in a scale from 1 to 4, where 1 represents complete preservation, and 4 represents complete removal of the neurovascular bundle, with 2 and 3 being partial preservation. This grade is recorded by the surgeon for each side, at the end of the procedure.) As such, sometimes it’s possible to preserve part of the bundle, even if there is a tumor on the same side

We designed a retrospective study to look at how high volume surgeons at MSKCC performed radical prostatectomy in high risk patients (how frequently and to what extent where the neurovascular bundles preserved), and what were the outcomes in terms of positive surgical margins (a surrogate for “leaving tumor behind”); use of additional oncologic treatments such as hormone therapy or radiotherapy, and finally, erectile function recovery in patients with functional erections before the operation. The patients in our cohort had at least one NCCN-defined high risk criteria (Gleason score ≥ 8; PSA ≥ 20 ng/ml; Clinical stage ≥ T3).

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Larger Study Finds No Link Between Melanoma and Viagra

Dr. Stacy Loeb, MD, MScDepartment of Urology, Population Health, and Laura and Isaac Perlmutter Cancer CenterNew York University, New York MedicalResearch.com Interview with:
Dr. Stacy Loeb, MD, MSc
Department of Urology, Population Health,
and Laura and Isaac Perlmutter Cancer Center
New York University, New York

Medical Research: What is the background for this study?

Dr. Loeb: A paper published last year suggested a relationship between use of sildenafil (Viagra) and melanoma.  That study had only 142 cases of melanoma, and of these men 14 had used sildenafil.  This study got a lot of publicity leading numerous patients to express concern over whether erectile dysfunction drugs could cause melanoma.

Our goal was to look more closely at this issue in a larger population from Sweden (including 4065 melanoma cases of whom 435 used any type of erectile dysfunction drug- Viagra, as well as Levitra and Cialis).  Sweden has a national health system so we were able to access prescription records for men across the entire country, which we linked to the national registries for melanoma and basal cell skin cancer.   Continue reading

2-3 Cups of Coffee Daily Linked To Lower Odds Of Erectile Dysfunction

David S. Lopez, Dr.P.H., M.P.H. Assistant professor University of Texas Health School of Public HealthMedicalResearch.com Interview with:
David S. Lopez, Dr.P.H., M.P.H.

Assistant professor
University of Texas Health School of Public Health

Medical Research: What is the background for this study? What are the main findings?

Dr. Lopez: Coffee, and its most studied component, caffeine, have been implicated in potential health benefits due to the rich sources of antioxidants and anti-inflammatory compounds contained in this beverage.

Caffeine intake reduced the odds of prevalent erectile dysfunction, especially an intake equivalent to approximately 2-3 daily cups of coffee (170-375 mg/day). This reduction was also observed among overweight/obese and hypertensive men, but not among diabetic men. These associations are warranted to be investigated in prospective studies.

Medical Research: What are the main findings?

Dr. Lopez: Caffeine intake reduced the odds of prevalent erectile dysfunction, especially an intake equivalent to approximately 2-3 daily cups of coffee (170-375 mg/day). This reduction was also observed among overweight/obese and hypertensive men, but not among diabetic men. These associations are warranted to be investigated in prospective studies.

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Screening Men with ED For Heart Disease May Be Cost Effective

Alexander W. Pastuszak, MD, PhD Male Reproductive Medicine and Surgery Scott Department of Urology Baylor College of Medicine Houston, TX MedicalResearch.com Interview with:
Alexander W. Pastuszak, MD, PhD
Male Reproductive Medicine and Surgery
Scott Department of Urology
Baylor College of Medicine Houston, TX

 

Medical Research: What is the background for this study?

Dr. Pastuszak: The link between erectile dysfunction (ED) and cardiovascular disease (CVD) has been growing stronger in recent years, and recommendations have recently been made to screen men with ED for CVD risk factors.  The arteries in the penis are much smaller than those in the heart, and if vascular disease contributes to ED, which we know it does, then ED should be detected before CVD in affected men.  We also know that treating men with CVD risk factors results in improvement in their risk of having acute cardiovascular events (i.e. heart attack, stroke, etc.).  Because of these relationships, we wanted to assess the economic impact of screening men with erectile dysfunction for CVD, identifying men with CVD risk factors, and treating these men on the incidence of cardiovascular events and new cases of ED.  Specifically, we wanted to look at the costs associated with screening and treatment of CVD and erectile dysfunction, and the cost savings resulting from screening and treating men with CVD risk factors and ED when preventing acute cardiovascular events.

Medical Research: What are the main findings?

Dr. Pastuszak: We modeled the reduction in acute cardiovascular events and the associated cost savings over 20 years.  We predicted that approximately 5.8 million men with both CVD and ED would be identified over 20 years if we screened men with ED for CVD risk factors, and the cost of this screening would be $2.7 billion.  We assumed that if we treated these at-risk men, there would be an approximately 20% decrease in cardiovascular events, which would prevent 1.1 million cardiovascular events over 20 years, saving $21.3 billion that would otherwise be put to treatment of these acute events.  Since ED and CVD arise from the same pathology, we predicted that in treating the CVD risk factors, a similar decrease in ED cases would be seen as well, which would save $9.7 billion that would otherwise be put to ED treatment.  In screening these men, a combined $28.5 billion would be saved over 20 years.

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Does Cialis Work For Erectile Dysfunction in Men afer Prostate Cancer Radiation?

Dr. Thomas M. Pisansky MD Mayo Clinic, Rochester, MinnesotaMedicalResearch.com Interview with:
Dr. Thomas M. Pisansky MD
Mayo Clinic, Rochester, Minnesota

MedicalResearch.com: What are the main findings of the study?

Dr. Pisansky: This patient-reported outcomes research did not identify a beneficial effect of once-daily tadalafil to prevent radiotherapy-related erectile dysfunction in men with prostate cancer.

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